Doctor Name: | VICKI LYNE CLARK |
NPI Number: | 1184790859 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED. |
License Number: | E 0002811 |
Business Practice Address: | 12557 Ravenwood Dr Chardon, OH - 440249009 |
Business Phone Number: | 4402853568 |
Business Fax Number: | 4402854552 |
Mailing Address: | 7068 Constantine Ct, MENTOR |
State: | OH |
Postal Code: | 440605124 |
Phone Number: | 4409426135 |
Fax Number: | |
NPI Enumeration Date: | 11/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | E 0002811 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |